Form 8s - Small Issue Registration - Document And Disclosure Checklist

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SECURITIES AND BUSINESS REGULATION  
 
                                            237 Coliseum Drive  
                                               Macon, Georgia 31217‐3858 
(478) 207‐2440 
                                    
 
SMALL ISSUE REGISTRATION 
Document and Disclosure Checklist 
Georgia Securities Act of 1973, As Amended OCGA 10‐5‐5(e) 
 
 
 
              
                      
APPLICANT: 
              
 
  
  
Office Use ONLY 
Control #: __________ 
Examiner: __________  
 
Description of Document/Disclosure 
OCGA 10‐5 
Circle A or B
1.   STATUTORY LIMITATION  (
) 
5(e)(1)(A) 
Regulation D ‐ Rule 504 
A.  Maximum aggregate offering of $1,000,000 with an unlimited 
number of investors; OR 
5(e)(1)(B) 
B.  Maximum of 50 investors with an unlimited aggregate offering 
2.    APPLICATION FOR REGISTRATION 
5(e)(2) 
A.  Complete all applicable parts of Form 8 
B.  Document and Disclosure Checklist 
C.  Manual signatures of officers and directors 
3.    CORPORATE DOCUMENTS 
5(e)(2) 
A.  Articles of Incorporation 
B.  Bylaws 
C.  Management or other material contracts 
5(e)(3)(E) 
D.  Indenture or other instrument relating to the securities to be 
5(e)(2) 
registered 
E.  Consent to Service of Process 
6(c) 
F.  Corporate resolution authorizing consent 
6(c) 
G.  Date and place organized 
5(e)(3)(A) 
4.    DESCRIPTION OF OFFERING 
5(e)(3)(C) 
A.  Type of securities  
B.  Number offered  
C.  Offering price and how computed  
D.  Aggregate offering  
E.  General purpose of offering  
F.  Specific use of proceeds  
G.  Commission, discounts and expenses of offering  
 
5.    DIRECTORS, OFFICERS AND CONTROL PERSONS 
5(e)(3)(D) 
A.  Compensation to officers, directors and affiliates 
12(a)(2) 
B.  Statement concerning all previous securities or proposed 
5(e)(3)(D) 
transactions with issuer 
C.  Material interest in any material transaction within past three 
5(e)(3)(D) 
years, or any proposed transaction 
6.   ESCROW 
6(e); 590‐4‐3‐.01 
A.  Minimum business plan  
B.  Agreement to escrow securities  
C.  Agreement in escrow proceeds  
D.  Petition for waiver of escrow  
E.  Letter from escrow agent regarding release of funds notification  

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